Mark Carroll Guerdan, D.O.
Individual provider Active NPI Anesthesiology Physician · Riverdale, GA
NPI 1326089574 · NPPES record last updated Jul 14, 2014
Key facts
- NPI
- 1326089574
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Anesthesiology Physician 207L00000X
- License
- 61081 (GA)
- Practice address
- 6525 Professional PL
Suite B
Riverdale, GA 30274-2519 - Phone
- (404) 254-5496
- Fax
- (404) 254-5829
- NPI assigned
- Jun 9, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31403 | KY | MD | Registered Nurse |
| 62257 | NY | MD | Anesthesiology Physician |
| 61081 | GA | MD | Pain Medicine Physician |
| 3148 | KY | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Triangle Anesthesia Group PSC | Anesthesiology | Past | Accepting new patients |
| Ozarks Medical Center | Pain Medicine | Past | Accepting new patients |
| Ashland Anesthesia, P.S.C. | Anesthesiology | Past | Accepting new patients |
| Amsol Physicians of Columbus Ga | Anesthesiology | Past | Accepting new patients |
| Hutcheson Anesthesia & Pain Treatment, LLC | Anesthesiology | Past | Accepting new patients |
| Amsol Physicians of Columbus Ga LLC | Anesthesiology | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 31403 | KY | |
| Anesthesiology Physician | 207L00000X | 62257 | NY | |
| Pain Medicine (Anesthesiology) Physician | 207LP2900X | 061081 | GA | |
| Interventional Pain Medicine Physician | 208VP0014X | 061081 | GA | |
| Anesthesiology Physician | 207L00000X | 61081 | GA | Yes |
| Pain Medicine Physician | 208VP0000X | 61081 | GA | |
| Pain Medicine (Anesthesiology) Physician | 207LP2900X | 61081 | GA |
Addresses
Primary practice location
6525 Professional PL
Suite B
Riverdale, GA 30274-2519
Mailing address
6525 Professional PL
Suite B
Riverdale, GA 30274-2519
Phone (404) 254-5496
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003135346A | Medicaid | GA | |
| 003135345A | Medicaid | GA |
Other providers in Riverdale, GA
- Grace Within Healthcare LLC
- Kennedy Briana-Marie Gray
- Tamara Aundrea Green
- Ashonta Dee Gresham
- Phyllis Grier
- Guide to the Right Path
- Krishan G Gupta
- Linda Gwin
- Gwinnett Multi Specialty Group LLC
- Elizabeth L Hadley
All providers in Riverdale, GA · Anesthesiology Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 14, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.